Frontiers in Cardiovascular Medicine最新文献

{"title":"Burden, risk factors, and projections of ischemic heart disease in China (1990-2021): findings from the 2021 GBD study.","authors":"Sikai Xu, Zhiyang Liu, Mu Tang, Chunli Xu","doi":"10.3389/fcvm.2025.1549147","DOIUrl":"10.3389/fcvm.2025.1549147","url":null,"abstract":"<p><strong>Background: </strong>Ischemic heart disease (IHD) remains a major public health challenge in China. This study aimed to comprehensively analyze the burden of IHD, its risk factors, and future trends from 1990 to 2021 using the Global Burden of Disease database.</p><p><strong>Methods: </strong>We assessed IHD trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs) stratified by age (greater than 15 years) and gender. Age-standardized rates, average annual percentage changes, and joinpoint regression analyses were used to evaluate temporal trends. Decomposition and frontier analyses were conducted to identify key contributors to the IHD burden, while future projections were generated for the next 15 years.</p><p><strong>Results: </strong>In 2021, the number of IHD incident cases, prevalent cases, deaths, and DALYs in China were 3.17, 3.25, 3.57, and 2.62 times higher than those in 1990, respectively. Age-standardized mortality rates and age-standardized DALYs rates demonstrated an initial increase, followed by a gradual decline. Males showed higher IHD burden during middle age, while elderly females surpassed males in the later years. Aging, high systolic blood pressure, ambient particulate matter pollution, elevated low-density lipoprotein cholesterol, and smoking were the primary drivers of IHD burden. Future projections suggest a declining incidence and prevalence among males but increasing trends in females, with DALYs expected to rise significantly in the female population.</p><p><strong>Conclusions: </strong>The burden of IHD in China has evolved significantly over the past three decades, driven by demographic and environmental factors. While prevalence and incidence have risen, mortality and DALYs have shown a recent decline, reflecting shifts in disease patterns. Age and gender disparities are evident, with middle-aged males and elderly females disproportionately affected. Key contributors, such as high blood pressure and pollution, highlight the need for targeted interventions. Gender-specific public health strategies, alongside improved environmental and health policies, are essential to mitigating the future burden of IHD in China.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1549147"},"PeriodicalIF":2.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bioinformatics analysis of the expression of potential common genes and immune-related genes between atrial fibrillation and chronic kidney disease.","authors":"Jieying Teng, Guoxiong Deng","doi":"10.3389/fcvm.2025.1521722","DOIUrl":"10.3389/fcvm.2025.1521722","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Research objective: &lt;/strong&gt;This study is based on bioinformatics analysis to explore the co-expressed differentially expressed genes (DEGs) between atrial fibrillation (AF) and chronic kidney disease (CKD), identify the biomarkers for the occurrence and development of the two diseases, investigate the potential connections between AF and CKD, and explore the associations with immune cells.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We downloaded Two AF gene chip datasets (GSE79768, GSE14975) and two CKD gene chip datasets (GSE37171, GSE120683) from the GEO database. After pre-processing and standardizing the datasets, two DEGs datasets were obtained. The DEGs were screened using R language, and the intersection was taken through Venn diagrams to obtain the co-expressed DEGs of AF and CKD. To obtain the signal pathways where the co-expressed DEGs were significantly enriched, GO/KEGG enrichment analyses were used to analysis the co-expressed DEGs. The Cytoscape software was used to further construct a PPI network and screen key characteristic genes, and the top 15 co-expressed DEGs were screened through the topological algorithm MCC. To further screen key characteristic genes, two machine-learning algorithms, LASSO regression and RF algorithm, were performed to screen key characteristic genes for the two disease datasets respectively to determine the diagnostic values of the characteristic genes in the two diseases. The GeneMANIA online database and Networkanalyst platform were used to construct gene-gene and TFs-gene interaction network diagrams respectively to predict gene functions and find key transcription factors. Finally, the correlation between key genes and immune cell subtypes was performed by Spearman analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Research results: &lt;/strong&gt;A total of 425 DEGs were screened out from the AF dataset, and 4,128 DEGs were screened out from the CKD dataset. After taking the intersection of the two, 82 co-expressed DEGs were obtained. The results of GO enrichment analysis of DEGs showed that the genes were mainly enriched in biological processes such as secretory granule lumen, blood microparticles, complement binding, and antigen binding. KEGG functional enrichment analysis indicated that the genes were mainly enriched in pathways such as the complement coagulation cascade, systemic lupus erythematosus, and Staphylococcus aureus infection. The top 15 DEGs were obtained through the MCC topological algorithm of Cytoscape software. Subsequently, based on LASSO regression and RF algorithm, the key characteristic genes of the 15 co-expressed DEGs of AF and CKD were further screened, and by taking the intersection through Venn diagrams, five key characteristic genes were finally obtained: PPBP, CXCL1, LRRK2, RGS18, RSAD2. ROC curves were constructed to calculate the area under the curve to verify the diagnostic efficacy of the key characteristic genes for diseases. The results showed that RSAD2 had the highest diagnostic value for AF, ","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1521722"},"PeriodicalIF":2.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"cMyBP-C in hypertrophic cardiomyopathy: gene therapy and small-molecule innovations.","authors":"Patrick T Wood, Morgan M Seffrood, Brett A Colson, Julian E Stelzer","doi":"10.3389/fcvm.2025.1550649","DOIUrl":"10.3389/fcvm.2025.1550649","url":null,"abstract":"<p><p>Hypertrophic cardiomyopathy (HCM) is a genetic disorder in the heart caused by variants in sarcomeric proteins that disrupt myocardial function, leading to hypercontractility, hypertrophy, and fibrosis. Optimal cardiac function relies on the precise coordination of thin and thick filament proteins that control the timing, magnitude of cellular force generation and relaxation, and <i>in vivo</i> systolic and diastolic function. Sarcomeric proteins, such as cardiac myosin binding protein C (cMyBP-C) play a crucial role in myocardial contractile function by modulating actomyosin interactions. Genetic variants in cMyBP-C are a frequent cause of HCM, highlighting its importance in cardiac health. This review explores the molecular mechanisms underpinning HCM and the rapidly advancing field of HCM translational research, including gene therapy and small-molecule interventions targeting sarcomere function. We will highlight novel approaches, including gene therapy using recombinant AAV vectors and small-molecule drugs targeting sarcomere function.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1550649"},"PeriodicalIF":2.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11935118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A giant and rapid myocardial remodeling due to fatal giant cell myocarditis: a case report.","authors":"Wei Zhang, Tao Guo","doi":"10.3389/fcvm.2025.1488503","DOIUrl":"10.3389/fcvm.2025.1488503","url":null,"abstract":"<p><p>Giant cell myocarditis is a rare and rapidly progressive disease with a high mortality rate. We present the case of a 21-year-old male without a medical history who presented with a giant left ventricle (9.9 cm, EF:10%) and in a severe clinical state. Cardiac MRI and virology raised the suspicion of giant cell myocarditis. Concerned about the hemodynamic and respiratory deterioration, we initiated cardiac transplant therapy. A fatal ventricular fibrillation occurs while waiting for the heart transplant. Sudden death could represent the \"first symptom\" of pathological findings. It is important to recognize that while sudden death due to giant cell myocarditis may be rare, it is still a potentially serious complication of giant cell infection and should be considered in cases of unexplained sudden death. In addition, this case highlights the challenges in the diagnosis and management of giant cell myocarditis and the need for early recognition and aggressive treatment.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1488503"},"PeriodicalIF":2.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of HDAC2 inhibition in cardioprotection against doxorubicin-induced myocardial injury.","authors":"Jinsha Liu, Wenwen Fu, Xue Wang, Zuowen Liang, Fanbo Meng","doi":"10.3389/fcvm.2025.1557119","DOIUrl":"10.3389/fcvm.2025.1557119","url":null,"abstract":"<p><strong>Introduction: </strong>The molecular mechanisms underlying cardioprotection against doxorubicin (DOX)-induced myocardial injury are poorly understood. Histone deacetylase 2 (HDAC2) plays a significant role in oxidative stress, apoptosis, and mitochondrial dysfunction and is implicated in many human diseases, This study investigated the relationship between HDAC2 expression and DOX-induced myocardial injury using the <i>in vivo</i> rat model of DOX-induced cardiotoxicity and <i>in vitro</i> experiments with the H9c2 cardiomyocytes.</p><p><strong>Methods: </strong>The rat model of DOX-induced myocardial injury was established by administering DOX via intraperitoneal injections. HDAC2 expression was suppressed by administering rats with sodium butyrate (SB) via intraperitoneal injections. Echocardiography measurements were performed at baseline and on day 15 post-treatment. The rats were euthanized on day 15 and cardiac tissues were harvested. The cardiac tissue samples were analyzed by hematoxylin and eosin H&E staining, immunohistochemistry, Masson staining, Sirius Red staining, TUNEL staining, and western blotting to determine the status of HDAC2 expression and myocardial apoptosis. In the vitro experiments, H9c2 cells were treated with DOX. HDAC2 expression was suppressed using sodium butyrate or transfected cells with the shRNA knockdown HDAC2 (shHDAC2). The H9c2 cells from different groups were analyzed by Rt-qPCR, CCK-8 cell viability assay, and western blotting to determine the status of HDAC2 expression and cardiomyocyte apoptosis.</p><p><strong>Results: </strong>DOX treatment induced cardiac dysfunction in rats. The cardiac tissues of the DOX-treated rats and H9c2 cells showed significantly higher levels of HDAC2 compared to the corresponding controls. However, inhibition of HDAC2 significantly mitigated DOX-induced myocardial injury in rats. This suggested a strong association between HDAC2 expression and DOX-induced myocardial injury. In the H9c2 cells, HDAC2 knockdown by shHDAC2 alleviated DOX-induced apoptosis by enhacing AKT phosphorylation. These findings demonstrated that HDAC2 silencing protected against DOX-induced cardiomyocyte apoptosis by activating the PI3K/AKT signaling pathway.</p><p><strong>Conclusion: </strong>Suppressing HDAC2 protected against DOX-induced cardiomyocyte apoptosis by activating the PI3K/AKT signaling pathway. Therefore, HDAC2 is a promising therapeutic target for mitigating DOX-induced myocardial injury.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1557119"},"PeriodicalIF":2.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic endograft infection after thoracic endovascular aortic repair: two case reports and literature review.","authors":"Danping Peng, Guang Xu, Bin Wang, Xin Li, Yang Wang","doi":"10.3389/fcvm.2025.1549613","DOIUrl":"10.3389/fcvm.2025.1549613","url":null,"abstract":"<p><p>With the maturity of thoracic endovascular aortic repair (TEVAR) technology and its increasing application in clinical practice, complications and long-term management after TEVAR have become issues of concern. Here, we report two cases of TEVAR for thoracic aortic dissection. One patient developed recurrent fever 6 years after TEVAR and underwent multiple courses of antibiotic therapy with a poor response. He came to our hospital 6 months later and presented with gastrointestinal bleeding. Imaging revealed the presence of an aortic abscess around the stent graft involving the esophagus and mediastinum. The patient's condition deteriorated rapidly after admission, and he ultimately succumbed to hemorrhagic shock. Another patient developed recurrent fever 1 year after surgery. Imaging studies suggested an aortic abscess with involvement of the esophagus, and the patient chose conservative treatment. After long-term anti-infective treatment, the infected lesions remained but had decreased in size. Aortic endograft infection complicated by multiple organ involvement is a rare complication of TEVAR and has a high mortality rate. After an extended postsurgical period, patients who have undergone TEVAR often lack regular follow-up and are easily overlooked. Our cases highlight the importance of early prevention, early diagnosis, and appropriate management of late complications following TEVAR.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1549613"},"PeriodicalIF":2.8,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Fatal atrioesophageal fistula following atrial fibrillation ablation-critical reflections on prevention.","authors":"Qi Dai, Shutong Chen, Ye Yuan, Yinghao Du, Kuixin Fan, Jingfeng Zhang, Jianjun Zheng","doi":"10.3389/fcvm.2025.1493259","DOIUrl":"10.3389/fcvm.2025.1493259","url":null,"abstract":"<p><p>Radiofrequency ablation (RFA) is an important therapeutic modality for atrial fibrillation (AF), widely utilized in clinical practice due to its safety and significant efficacy. However, post-procedural complications may arise, influenced by anatomical positioning and the intensity of ablation energy, with atrioesophageal fistula (AEF) being particularly rare yet severe. This case report describes a unique instance of a patient developing AEF following AF ablation, accompanied by ischemic stroke and myocardial infarction. A 71-year-old male admitted to the emergency department on July 19, 2024, with acute loss of consciousness and convulsions. Upon admission, physical examination and laboratory tests revealed vital signs within abnormal ranges and indicators suggesting inflammation and potential myocardial injury. Head CT scans showed hypoattenuating areas indicative of cerebral infarction, chest CT suggested possible air accumulation in the left atrial region. ECG findings were consistent with atrial flutter, myocardial infarction, and incomplete right bundle branch block. Given his history of atrial fibrillation and RFA, alongside clinical manifestations, the patient was diagnosed with cardio-cerebral syndrome, suspected to be complicated by an AEF due to the presence of air in the left atrium. AEF diagnosis was confirmed via cardiac CTA, leading to conservative management decisions. Despite initiating thrombolysis for cerebral infarction and supportive treatments for heart failure, including VA-ECMO, the patient's condition continued to decline, evidenced by cardiogenic shock, heart failure, and progressive neurological deficits including coma and dilated non-reactive pupils. Ultimately resulting in family-elected discharge against medical advice on the fourth day of hospitalization.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1493259"},"PeriodicalIF":2.8,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the exercise intensity equivalent to the anaerobic threshold in patients with acute myocardial infarction based on the 6-minute walk test distance.","authors":"Yuxuan Fan, Xiaopeng Sun, Guihua Li, Xiaojing Wang, Qian Luo, Lemin Wang, Yuqin Shen, Zhiqing Fan","doi":"10.3389/fcvm.2025.1452802","DOIUrl":"10.3389/fcvm.2025.1452802","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the correlation between aerobic exercise intensity based on the 6 min walk test (6MWT) and the anaerobic threshold (AT)-based equivalent in patients with acute myocardial infarction (AMI). The feasibility of using the 6MWT for exercise prescription in primary care settings was also investigated.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on data from AMI patients, including statistics on all values of the cardiopulmonary exercise test and 6MWT parameters.</p><p><strong>Results: </strong>Regression analysis showed that the regression equation based on 6MWD exercise intensity (EI_6MWD) could predict AT-based exercise intensity (EI_AT). Moreover, EI_6MWD correlated with EI_AT in 91.9%-93.0% of patients' EI_6MWD, with AMI equivalent to the EI_AT model.</p><p><strong>Conclusions: </strong>The findings suggest that the anaerobic threshold in AMI patients corresponds to 91.9%-93.0% of the distance covered during the 6MWT. Thus, the 6MWT is a feasible tool for developing exercise prescriptions in primary care hospitals.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1452802"},"PeriodicalIF":2.8,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-dose modified bloodless del Nido cardioplegia for minimally invasive cardiac surgery.","authors":"Heemoon Lee, Jihoon Kim, Jae Suk Yoo","doi":"10.3389/fcvm.2025.1448310","DOIUrl":"10.3389/fcvm.2025.1448310","url":null,"abstract":"<p><strong>Background: </strong>Recent studies demonstrated satisfactory results of del Nido cardioplegia in minimally invasive cardiac surgery (MICS). We aimed to evaluate the efficacy of our modified \"bloodless\" del Nido cardioplegia in MICS compared to the histidine-tryptophan-ketoglutarate (HTK) solution.</p><p><strong>Methods: </strong>We retrospectively reviewed 471 patients who underwent minimally invasive cardiac surgery (MICS) in our institution between January 2015 and September 2022. Patients were divided into HTK (<i>n</i> = 96) and bloodless del Nido (<i>n</i> = 375) groups. Using propensity score matching, we matched 72 patients with bloodless del Nido to 72 patients with HTK, based on demographic and operative information.</p><p><strong>Results: </strong>There were no significant differences in the baseline characteristics and operative data after matching. The early mortality and morbidities did not differ significantly between the two groups. Freedom from overall mortality did not differ significantly during the follow-up period (97.2% in HTK vs. 98.6 in bloodless del Nido at 2 years, <i>P</i> = 0.56). The two groups had no difference in postoperative lactate levels at 6 and 24 h. Various statistical methods consistently indicated that bloodless del Nido cardioplegia did not increase risks for overall mortality.</p><p><strong>Conclusions: </strong>The modified bloodless del Nido cardioplegia showed comparable postoperative outcomes in MICS compared with the HTK solution, suggesting its potential as an alternative option for MICS.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1448310"},"PeriodicalIF":2.8,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel device therapies in heart failure: focus on patient selection.","authors":"Amrita Balgobind, Daniel Asemota, Emily Rodriguez, Phuuwadith Wattanachayakul, Marat Fudim, Miguel Alvarez Villela","doi":"10.3389/fcvm.2025.1419873","DOIUrl":"10.3389/fcvm.2025.1419873","url":null,"abstract":"<p><p>The increasing prevalence of heart failure (HF) has led to advancements in therapeutic strategies, including the development of new pharmacological treatments and the expansion of guideline recommendations across the spectrum of left ventricular ejection fractions. Despite these advancements, the full benefits of guideline-directed medical therapy (GDMT) are often limited by various barriers that result in incomplete implementation or suboptimal responses. For patients who cannot tolerate or only partially respond to GDMT, therapeutic options remain limited. This gap is particularly significant for those with contraindications to heart replacement therapies (HRT), such as left ventricular assist device (LVAD) or heart transplant. In light of these potential limitations, this review article proposes categorizing HF patients into four distinct phenoprofiles based on their tolerance to GDMT and candidacy for HRT. Considering these HF phenoprofiles may guide treatment decisions regarding the selection and use of novel device-based HF therapies. Furthermore, we summarize data on commercially available and emerging device-based HF therapies, evaluating their clinical utility, mechanisms of action, and selection criteria based on current evidence. Finally, we describe clinical cases across various proposed HF phenoprofiles to illustrate how these HF profiles can guide the use of novel device-based therapies to achieve clinical stability, improve GDMT tolerance, or serve as a bridge to, or be used in tandem with HRT in select patients.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1419873"},"PeriodicalIF":2.8,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}